Rationale: Because encouraging rates for hospital and long-term survival of immunocompromised patients in ICUs have been described, these patients are more likely to receive invasive therapies, like extracorporeal membrane oxygenation (ECMO).Objectives: To report outcomes of immunocompromised patients treated with ECMO for severe acute respiratory distress syndrome (ARDS) and to identify their pre-ECMO predictors of 6-month mortality and main ECMO-related complications.Methods: Retrospective multicenter study in 10 international ICUs with high volumes of ECMO cases. Immunocompromised patients, defined as having hematological malignancies, active solid tumor, solid-organ transplant, acquired immunodeficiency syndrome, or long-term or high-dose corticosteroid or immunosuppressant use, and severe ECMO-treated ARDS, from 2008 to 2015 were included.Measurements and Main Results: We collected demographics, clinical data, ECMO-related complications, and ICU- and 6 month-outcome data for 203 patients (median Acute Physiology and Chronic Health Evaluation II score, 28 [25th-75th percentile, 20-33]; age, 51 [38-59] yr; PaO2/FiO2, 60 [50-82] mm Hg before ECMO) who fulfilled our inclusion criteria. Six-month survival was only 30%, with a respective median ECMO duration and ICU stay of 8 (5-14) and 25 (16-50) days. Patients with hematological malignancies had significantly poorer outcomes than others (log-rank P = 0.02). ECMO-related major bleeding, cannula infection, and ventilator-associated pneumonia were frequent (36%, 10%, and 50%, respectively). Multivariate analyses retained fewer than 30 days between immunodeficiency diagnosis and ECMO cannulation as being associated with lower 6-month mortality (odds ratio, 0.32 [95% confidence interval, 0.16-0.66]; P = 0.002), and lower platelet count, higher Pco2, age, and driving pressure as independent pre-ECMO predictors of 6-month mortality.Conclusions: Recently diagnosed immunodeficiency is associated with a much better prognosis in ECMO-treated severe ARDS. However, low 6-month survival of our large cohort of immunocompromised patients supports restricting ECMO to patients with realistic oncological/therapeutic prognoses, acceptable functional status, and few pre-ECMO mortality-risk factors.

AP HP Bichat Hospital Medical and Infectious Diseases Intensive Care Unit Paris Diderot University Sorbonne Paris Cité INSERM Paris Diderot University Paris France

Department of Anaesthesia and Intensive Care 1st Medical Faculty Charles University General University Hospital Prague Czech Republic

Department of Intensive Care Erasmus MC University Medical Center Rotterdam the Netherlands

Department of Intensive Care Hôpital Erasme Université Libre de Bruxelles Brussels Belgium

Department of Medicine 1 Intensive Care Unit 13i2 Medical University of Vienna Vienna Austria

Department of Pulmonary Allergy and Critical Care Medicine Hallym University Sacred Heart Hospital Anyang Korea; and

Medical Intensive Care Unit Hôpital de la Pitié Salpêtrière Assistance Publique Hôpitaux de Paris Paris France

School of Medicine and Surgery University of Milan Bicocca Department of Emergency and Intensive Care San Gerardo Hospital Monza Italy

Service de Réanimation Médicale Centre Hospitalier Universitaire d'Angers Angers France

Sorbonne Universités UPMC University Paris 06 INSERM UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique AP HP Groupe Hospitalier Pitié Salpêtrière Charles Foix Service de Pneumologie et Réanimation Médicale Paris France

Sorbonne Universités UPMC University Paris 06 INSERM UMRS_1166 Institute of Cardiometabolism and Nutrition Paris France

Am J Respir Crit Care Med. 2018 May 15;197(10):1241-1243. doi: 10.1164/rccm.201801-0036ED. PubMed

J Thorac Dis. 2019 Mar;11(Suppl 3):S425-S427. doi: 10.21037/jtd.2018.11.46. PubMed

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